(Required Rotation) Learning Experience Description Xxxx xxxx, Pharm.D., BCPS xxxx.xxxx@xxxx.org xxxxx xxxxx, Pharm.D., BCPS xxxxx.xxxxxxxx@xxxxx.org xxxx xxxxx, PharmD, BCPS xxxx.xxxxx@xxxx.org I. General Description: (IM) is a five week learning experience at Stellar Hospital developed to provide the opportunity for residents to manage acutely ill patients with a variety of disease states. The pharmacy resident is responsible for identifying and resolving medication therapy issues for patients and will work towards assuming care of all patients on the team prior to the completion of the learning experience. The resident will participate in and provide clinical pharmacy activities including but not limited to: Therapeutic drug monitoring services (ie aminoglycosides, anticoagulants, nutrition, and vancomycin) Education of patients, providers, ancillary staff, or pharmacy students Patient case discussions, topic discussions and journal clubs Drug information requests The resident should ensure safe and effective use of all medications including medication and/or dose adjustment when needed (based on culture results, renal function, weight, monitoring parameters) Excellent communication skills and interpersonal skills are essential for success in this experience. The resident must develop and implement time management skills to efficiently accomplish the required activities during this experience. At the end of the rotation, the resident should be able to efficiently review a patient and identify pharmacotherapeutic problems, implement medication regimens, develop a plan with measurable endpoints and subsequently monitor the regimens for effectiveness and adverse effects. II. Disease States: Common disease states to be covered via patient experiences, topic discussions, and/or literature review may include, but are not limited to: Anemia Asthma/COPD Catheter-related Infections Common Infectious Diseases Chronic Kidney Disease Diabetes Mellitus Acute Coronary Syndromes (ACS) Hypertension Acute Renal Failure Heart Failure Pneumonia Renal Replacement Therapy Hyperlipidemia Cerebrovascular Accidents (CVA) Page 1 of 5
III. Required Readings The resident is expected to read background information and current primary literature to be familiar with all disease states and medications related to the patients on the medical team. The resident is responsible for selecting reading materials for topic discussion and journal club, but the resident should have reading material approved by the preceptor in a timely manner. IV. Goals Selected: Goals selected to be taught and evaluated during this learning experience include: R1.4 Demonstrate ownership of and responsibility for the welfare of the patient by performing all necessary aspects of the medication-use system. R2.1 As appropriate, establish collaborative professional relationships with members of the health care team. R2.2 Place practice priority on the delivery of patient-centered care to patients. R2.7 Design evidence-based monitoring plans R2.8 Recommend or communicate regimens and monitoring plans R2.9 Implement regimens and monitoring plans. R2.10 Evaluate patients progress and redesign regimens and monitoring plans. V. Activities Goals and Objectives Outcome R1: Manage and improve the medication-use process Activities to Facilitate Professional Growth Goal R1.4 Demonstrate ownership of and responsibility for the welfare of the patient by performing all necessary aspects of the medication-use system. OBJ R1.4.1 (Characterization) Display initiative in preventing, identifying, and resolving pharmacy-related patient-care problems. Explain the role of the pharmacist in preventing, identifying, and resolving pharmacy-related patient-care problems. Explain the importance of assertiveness in presenting pharmacy concerns, solutions, and interests. Explain and understand the interdependent relationship between operational tasks and clinical activities. Perform follow-through for any interventions implemented. Outcome R2: Provide evidence-based, patient centered medication therapy management with interdisciplinary teams Goal R2.1 As appropriate, establish collaborative professional relationships with members OBJ R2.1.1 Goal R2.2 OBJ R2.2.1 of the health care team. (Synthesis) Implement a strategy that effectively establishes cooperative, collaborative, and communicative working relationships with members of interdisciplinary health care teams. Actively participate in multidisciplinary rounds on a daily basis and communicate while on rounds or prior to rounds recommendations for therapeutic regimen changes or monitoring plan changes with the appropriate members of the health care team. Place practice priority on the delivery of patient-centered care to patients. (Organization) Choose and manage daily activities so that they reflect a priority on the delivery of appropriate patient-centered care to each patient. Organize schedule efficiently so that the resident has adequate time to preround daily and is fully prepared for rounds. Follow up within a timely manner Page 2 of 5
Goal R2.7 OBJ R2.7.1 Goal R2.8 OBJ R2.8.1 Goal R2.9 OBJ R2.9.1 OBJ R2.9.2 Goal R2.10 OBJ R2.10.1 Design evidence-based monitoring plans. (Synthesis) Design a patient-centered, evidenced-based monitoring plan for a therapeutic regimen that effectively evaluates achievement of the patientspecific goals. Recommend or communicate regimens and monitoring plans. (Application) Recommend or communicate a patient-centered, evidence-based therapeutic regimen and corresponding monitoring plan to other members of the interdisciplinary team and patients in a way that is systematic, logical, accurate, timely, and secures consensus from the team and patient. Implement regimens and monitoring plans. (Application) When appropriate, initiate the patient-centered, evidence-based therapeutic regimen and monitoring plan for a patient according to the organization's policies and procedures. (Application) Use effective patient education techniques to provide counseling to patients and caregivers, including information on medication therapy, adverse effects, compliance, appropriate use, handling, and medication administration. on all patient care issues in the afternoon while meeting other required responsibilities of the residency program. Construct patient specific monitoring plans that incorporate objective data and subjective patient progress to assess response to regimens while limiting adverse events. Rewrite monitoring plans based on a response to plans that were unanticipated. Prepare complete and appropriate recommendations for changes to the therapeutic plan for a specific patient and communicate this to the preceptor and interdisciplinary team members concisely. Select appropriate laboratory monitoring follow-ups based on the changes to the therapeutic regimen. Schedule these labs and document as appropriate. After orders have been written by the physicians, check orders to ensure accuracy of what was discussed and ensure appropriate monitoring has also been ordered. Ensure that any required communication is made to the appropriate person-nurse, physician, patient, or operational pharmacist. For patients without insurance or who require medication authorizations, assist clinical social workers in ensuring that patients receive discharge medications. Observe clinicians (RN, PharmD, MD) while they counsel patients. Counsel patients before discharge while preceptor observes. Practice counseling with preceptor and students. Evaluate patients progress and redesign regimens and monitoring plans. (Evaluation) Accurately assess the patient s progress toward the therapeutic goal(s). Assess patient s improvement towards expected therapeutic goals using the resident prepared patient profile, subjective information from the patient, and objective data from the electronic medical record and other documentation sources. Understand what the goals of therapy are and how to define them. Page 3 of 5
Discuss patient s therapeutic regimen and plan daily with preceptor. OBJ R2.10.2 (Synthesis) Redesign a patient-centered, evidence-based therapeutic plan as necessary based on evaluation of monitoring data and therapeutic outcomes. Compose a reconstructed therapeutic regimen and monitoring plan based on patients known objective and subjective developments during the admission. Discuss changes to therapeutic regimen and plan daily with preceptor. For each patient, develop an alternative treatment plan and discuss when to implement it. VI. Preceptor Interaction and Typical Daily/Weekly/Monthly Activities Daily: Pre-rounding should occur on all patients on the medical team prior to rounds. There is no formal data collection tool required, but the resident should be able to provide all pertinent information, including laboratory and medication data, to the rounding team and/or preceptor. Rounds typically begin at 0830, locations vary throughout the hospital. Contact your team in the morning to find out where and when they are meeting. Review of patients/patient related issues with preceptor Patient counseling/medication histories Communicating and providing education to medical staff, nurses, or staff pharmacists as needed Weekly: At least one topic discussion to be prepared and led by the resident (may be assigned topic, or residents choice depending on progression of the rotation); Preceptor may assign or lead discussions. End of the week informal feedback session with preceptor. Cumulative: Literature review will be expected, encouraged, and presented as part of daily patient presentations, formal topic discussions, and rounds with the medical team Attendance at P4 student presentations and other meetings as assigned by the preceptor Projects or in-services may be required or assigned during the course of the learning experience. Examples include: o Provide nursing education for policies and procedures pertinent to the floor o Protocol development relevant to the unit o Pharmacy education Expected progression of resident responsibility on this learning experience: Day 1: 0800 Preceptor to review rotation learning objectives and expectations with resident 0830 1000 Attend medicine rounds. 1000 1100 Medical residents/students morning report. The pharmacy resident is not expected to attend, unless specifically requested by the medical team or Page 4 of 5
preceptor. During this time the resident will follow-up on drug information requests or patient care issues. 1100 1245 Attendance at medicine rounds. 1400 1600 Table rounds with preceptor to review and discuss patient update, formal consults, topic discussions, etc Weeks 1-2 Weeks 3-5 Resident will work up assigned patients and discuss in rounding fashion with preceptor each day. Resident will resolve any concerns with team while on the rounds or via other verbal communication. Preceptor will be available for questions and will monitor patients independently to monitor residents development of skills. Preceptor will determine presence on round based on resident development. Resident will work towards and achieve the goal of taking responsibility for the review of all patients on the team daily. Preceptor will be available for review and discussion, and presence on rounds will be based on the resident s development. (The length of time the preceptor spends in each of the phases of learning will depend BOTH on the resident s progression in the current rotation and where the rotation occurs in the residency program). VII. Evaluation Strategy ResiTrak will be used for documentation of formal evaluations. At the beginning of the rotation, the resident will develop three personal goals for the rotation, which should be achievable in five weeks. For formal evaluation, the resident will be evaluated based on the Resident Learning System (RLS) during the rotation. Goals and objectives are listed above. Regular feedback will be given and solicited by the preceptor throughout the rotation. An informal midpoint evaluation will be performed in addition to a formal final evaluation. The resident is expected to provide feedback about their own performance and progress towards person goals/objective at each evaluation. What Who When Custom 3 Personal Goals for Rotation Resident/Preceptor Start of Rotation Informal Feedback Session Resident/Preceptor Weekly (Fridays) Custom 3 Personal Goals for Rotation Resident/Preceptor End of Rotation Summative Preceptor End of Rotation Summative Self Evaluation Resident End of Rotation Preceptor/Learning Experience Evaluation Resident End of Rotation Page 5 of 5